评估一项针对医护人员的培训项目以提高强奸幸存者护理质量：坦桑尼亚莫罗戈罗的一项准实验设计研究。
Evaluation of a training program for health care workers to improve the quality of care for rape survivors: a quasi-experimental design study in Morogoro, Tanzania.
作者信息
Abeid Muzdalifat, Muganyizi Projestine, Mpembeni Rose, Darj Elisabeth, Axemo Pia
机构信息
Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.
Department of Obstetrics/Gynecology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania;
出版信息
Glob Health Action. 2016 Jul 14;9:31735. doi: 10.3402/gha.v9.31735. eCollection 2016.
BACKGROUND
Sexual violence against women and children in Tanzania and globally is a human rights violation and a developmental challenge.
OBJECTIVE
The aim of this study was to assess the impact of training health professionals on rape management. The specific objectives were to evaluate the changes of knowledge and attitudes toward sexual violence among a selected population of health professionals at primary health care level.
DESIGN
A quasi-experimental design using cross-sectional surveys was conducted to evaluate health care workers' knowledge, attitude, and clinical practice toward sexual violence before and after the training program. The study involved the Kilombero (intervention) and Ulanga (comparison) districts in Morogoro region. A total of 151 health professionals at baseline (2012) and 169 in the final assessment (2014) participated in the survey. Data were collected using the same structured questionnaire. The amount of change in key indicators from baseline to final assessment in the two areas was compared using composite scores in the pre- and post-interventions, and the net intervention effect was calculated by the difference in difference method.
RESULTS
Overall, there was improved knowledge in the intervention district from 55% at baseline to 86% and a decreased knowledge from 58.5 to 36.2% in the comparison area with a net effect of 53.7% and a p-value less than 0.0001. The proportion of participants who exhibited an accepting attitude toward violence declined from 15.3 to 11.2% in the intervention area but increased from 13.2 to 20.0% in the comparison area.
CONCLUSIONS
Training on the management of sexual violence is feasible and the results indicate improvement in healthcare workers' knowledge and practice but not attitudes. Lessons learned from this study for successful replication of such an intervention in similar settings require commitment from those at strategic level within the health service to ensure that adequate resources are made available.
背景
在坦桑尼亚乃至全球范围内，针对妇女和儿童的性暴力都是对人权的侵犯，也是一项发展挑战。
目的
本研究旨在评估培训卫生专业人员对强奸处理的影响。具体目标是评估在初级卫生保健层面选定的卫生专业人员群体中，他们对性暴力的知识和态度的变化。
设计
采用横断面调查的准实验设计，以评估培训项目前后医护人员对性暴力的知识、态度和临床实践。该研究涉及莫罗戈罗地区的基洛姆贝罗（干预）区和乌朗加（对照）区。共有151名卫生专业人员在基线期（2012年）参与调查，169人在最终评估（2014年）时参与。使用相同的结构化问卷收集数据。通过干预前后的综合评分比较两个地区关键指标从基线到最终评估的变化量，并采用差值法计算净干预效果。
结果
总体而言，干预区的知识水平从基线时的55%提高到了86%，而对照区则从58.5%降至36.2%，净效果为53.7%，p值小于0.0001。干预区对暴力表现出接受态度的参与者比例从15.3%降至11.2%，而对照区则从13.2%升至20.0%。
结论
性暴力管理培训是可行的，结果表明医护人员的知识和实践有所改善，但态度没有改变。从本研究中吸取的经验教训，以便在类似环境中成功复制此类干预措施，这需要卫生服务战略层面的人员做出承诺，以确保提供足够的资源。
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